Parental perceptions of dental visits and access to dental care among disabled schoolchildren in Kuwait.

The objective of this study was to describe dental visiting habits and access to dental care among the disabled schoolchildren in Kuwait. A total of 308 parents of children with a physical disability (n = 211), Down syndrome (n = 97) and teachers, who had normal children (n = 112) participated in the study. Less than one-fourth (21%) of the disabled children and 37% of the normal children had never visited a dentist (p = 0.003). Majority of Down syndrome (72%) and physically disabled children (59%) received curative dental care compared to 47% of normal children (p = 0.016). A bigger proportion of disabled children (42%) visited the dentist due to tooth ache than the normal ones (25%) (p < 0.01). Only 9.6% of Down syndrome children perceived no barriers to seek the dental care compared to 26.2% of physically disabled and 32.2% of normal children (p = 0.008). Difficulty to get an appointment was the most common perceived barrier to dental care by parents of Down syndrome children and the normal children (37.3%). Parents of disabled children considered difficulty in cooperation as a more important barrier to treatment (34.7%) than the parents of normal children (20.3%). Larger proportion of parents of normal children (82%) rated the present dental services as excellent/good compared to 52% of the parents of disabled children (p < 0.001). Toothache and curative treatment need were the main reasons for dental visits among disabled children. Regular dental check-ups and preventive oral health care should be encouraged for comprehensive coverage of the national school oral health program for the disabled in Kuwait.

Oral hygiene status of Kuwaiti schoolchildren.

A national epidemiological survey of children aged 5-14 years was conducted in all 5 governorates of Kuwait in 2001 to determine the oral hygiene status of Kuwait in schoolchildren. Clinical examinations were carried out by calibrated dentists according to World Health Organization criteria. The debris index simplified (DI-S) score was used to assess oral hygiene status. Of the 3294 children, 3.9% were judged to have good oral hygiene (DI-S score: 0.3-0.6), 67% fair (score 0.7-1.8) and 29.1% poor (score 1.9-3.0). The overall level of oral hygiene in the schoolchildren surveyed was fair (mean score 1.5). DI-S scores were significantly higher for boys than girls (mean score 1.6 versus 1.5) but DI-S did not vary much by age. There were variations in DI-S scores across different governorates. Oral hygiene measures need to be reinforced for the schoolchildren in Kuwait and should form part of the school curriculum.

Oral hygiene status of Kuwaiti schoolchildren

A national epidemiological survey of children aged 5-14 years was conducted in all 5 governorates of Kuwait in 2001 to determine the oral hygiene status of Kuwaiti schoolchildren. Clinical examinations were carried out by calibrated dentists according to World Health Organization criteria. The debris index simplified [DI-S] score was used to assess oral hygiene status. Of the 3294 children, 3.9% were judged to have good oral hygiene [DI-S score: 0.3-0.6] 67% fair [score 0.7-1.8] and 29.1% poor [score 1.9-3.0]. The overall level of oral hygiene in the schoolchildren surveyed was fair [mean score 1.5]. DI-S scores were significantly higher for boys than girls [mean score 1.6 versus 1.5] but DI-S did not vary much by age. There were variations in DI-S scores across different governorates. Oral hygiene measures need to be reinforced for the schoolchildren in Kuwait and should form part of the school curriculum

Dental caries experience of Kuwaiti kindergarten schoolchildren.

OBJECTIVE: The aim of the present study was to determine the caries free proportions, caries experience and restorative care received in Kuwaiti kindergarten schoolchildren. METHODS; A national epidemiologic survey of the 4- and 5-year-old kindergarten schoolchildren (n = 1,277) was conducted in the five govemorates of Kuwait. Five trained and calibrated dentists examined the children. Dental caries was scored using WHO diagnostic criteria. RESULTS: The percentage of 4- and 5-year-old children with dft = 0 was 32% and 24% respectively. The corresponding mean dft/dfs for 4- and 5-year-olds were 3.7/6.9 and 4.8/9.6. The decayed score was the major component in the mean scores. There was a significant difference in caries experience by governorate, but no difference by gender. The restorative index for 4- and 5-year-olds was 9.4% and 14.1% respectively. CONCLUSIONS: Caries levels are lower or similar to those in neighbouring and other Middle East countries. A high percentage of carious maxillary incisors indicate an early childhood caries pattern in these children. An extensive prevention programmme in preschool and kindergarten children is now in place.

Field trial on caries prevention with xylitol candies among disabled school students.

BACKGROUND: In a 1999 survey high caries levels were found among physically disabled school students in Kuwait. OBJECTIVES: A field study was planned to test the efficacy of xylitol candies in preventing caries among individuals in two special schools in Kuwait. METHODS: Altogether 176 students were examined in 2002 and 145 (105 in xylitol group and 40 in the control group) after 18 months' intervention. The WHO criteria were used in recording caries according to surfaces (third molars were excluded) by 2 calibrated examiners (E.H., M.S.). The students were allocated to the xylitol group only if the parent/caregiver returned the informed consent form. School health nurses distributed xylitol candies to the students 3 times during the school day (after breakfast and lunch, and before leaving the school). RESULTS: In the xylitol group, the baseline DS and DMFS scores were 3.4 and 8.2 and in the follow-up 1.9 and 7.1, respectively. In the control group, the baseline scores were DS 3.9 and DMFS 9.8, and the follow-up scores DS 3.9 and DMFS 13.2. CONCLUSION: Xylitol seemed to have a strong preventive and a clear remineralizing effect on caries.

Behcet's disease.

Behcet's disease is a recurrent multisystem vasculitis that can affect any organ or system, but was originally described as orogenital ulcerations and uveitis. Specific criteria have been proposed for diagnosis and identification of affected organs by different national authorities. Behcet's disease is proposed to be due to an antigen/antibody reaction. The antigen can be external (microbial or other) or self-antigen. Self-antigens include HLA-B, S and interphotoreceptor retinoid binding protein, the oral mucosal antigens, and alphatropomycin. The antibody reaction manifests as changes common to any inflammatory process. Circulating immune complexes and neutrophil hyperactivity are present with the expression of adhesion molecules related to disease activity associated with phenotypic and functional aberrations affecting both Th1 and Th2 activity. The results in an increase of interleukin-4, -10, and -1B and interleukin-2 receptors with deficient interleukin-12, interferon-gamma, and expression of cell adhesion CDII/CD18, accompanied by increased B cells secreting IgG. The clinical picture varies according to the organ affected; emphasis is placed on those of diagnostic importance and those affecting morbidity and mortality. The histopathology demonstrates vasculitis with inflammatory cell infiltration, the endothelium expressing ICAM-1 and E-selectin, vascular occlusion with sequences. Treatment includes corticosteroids. Other immunosuppressant and biological agents include anti-tumor necrosis factor, interferon-alpha, Campath-1, and the S antigen. Colchicine and other miscellaneous therapies are included.

Immunopathogenesis of toxoplasmosis.

Toxoplasmosis is a ubiquitous infection affecting 500 million persons around the world, with a range of incidence 12%-90%, increasing with age, education, crowding and sanitary habits. Cats are the definitive host. Infection is primarily congenital but acquired ocular infection has been documented. The review focuses on the immunopathogenesis of toxoplasmosis with emphasis on the eye problem due to its morbidity. The response to infection correlates with both parasitic and retinal antigens. The clinical picture and histopathology is a reflection of the immune response which constitutes early humeral response which presents both systemically and locally primary infection and is elevated with reactivation. This is followed by the cellular response, varying from low grade monocular infilterate a total tissue destruction with response of live parasites especially in immuno-compromised patients. Penetration of the parasite and its enclosure within the parasitophorous vacuole and its eneyst all make its eradicatier impossible. This reflects the variability of antiparasitic therapy that include folate antagonists, macrolides, hydroxy naphthoquindones and fluoroquinolones. Use of corticosteroid should be limited to severe reactions and should be associated with specific therapy.

Dental caries experience of disabled children and young adults in Kuwait.

OBJECTIVE: The aim of the study was to assess the caries experience of disabled children and young adults in Kuwait, to set baseline data, and to determine their treatment need. METHOD: Dental caries was scored by surface in accordance with WHO criteria. The study population comprised 832 disabled children and young adults (3-29 years; mean age 12.1 years) who were visually impaired, hearing impaired, had physical handicaps or developmental disorders, attending special needs schools. RESULTS: The proportion of caries free subjects in the primary dentition (3-12-year-old children) was 11.2%. The mean dmft was 5.4, and dmfs 15.2, being highest in the Down's syndrome and lowest in the blind. The proportion of caries-free subjects in permanent dentition, over 5 years of age was 24.2%. The smallest percentage of caries-free subjects was found in the hearing impaired (16.4%) and highest percentage in the blind (35.5%). The mean DMFT was 4.5 and the DMFS 8.7, being highest in the Down's syndrome and lowest in the blind. Prevalence of untreated decay was highest in hearing impaired (86%). The caries experience of first permanent molars represented the largest proportion of the DMFT score (53.6%). In the permanent dentition increasing age, impaired hearing, and poor oral hygiene were significantly associated with caries risk. CONCLUSIONS: Caries experience among this disabled population was clearly higher than among the respective age groups in a previous national population survey. The study confirmed the need for strengthening organised preventive and restorative care for this population in Kuwait.

Malocclusions and traumatic injuries in disabled schoolchildren and adolescents in Kuwait.

The present study was carried out to determine the prevalence of malocclusion and traumatic injuries in disabled children and adolescents attending the special-needs schools in Kuwait. Included in the study were 818 children (438 males and 380 females), in the age groups of 3-20 years, who have visual impairment, hearing impairment, physical handicaps, or developmental disorders. The mean age of participants was 11.9 years. The survey was carried out according to the methods of WHO. The prevalence of severe malocclusion was 23.6%, and that of slight malocclusion was 37.0%. Children with Down syndrome (OR = 2.3; 95% CI = 1.51-3.52), those of increasing age (OR = 1.1; 95% CI = 1.01-1.10), and males (OR = 1.5; 95% CI = 1.05-2.07) had higher risk for the occurrence of severe malocclusion. Less than one-fifth of the subjects (16.9%) had traumatized anterior teeth. Severe malocclusion (OR = 1.8; 95% CI = 1.17-2.77) and increasing age (OR = 1.2; 95% CI = 1.13-1.26) were significant risk factors for the occurrence of traumatic injuries. We concluded that malocclusion and traumatic injuries are more prevalent among these subjects with disabilities than among the healthy population in Kuwait.

Sarcoidosis presenting as multilobular limbal corneal nodules.

PURPOSE: To review reported external ocular manifestations of sarcoidosis and to present bilateral, multilobular, nodular, limbal, corneal nodules as being a unique manifestation of the disease. PATIENTS AND METHODS: A 16-year-old Saudi girl presented with bilateral, multilobular, solid, limbal nodules, with a vascular supply from the conjunctival vessel, and associated membraneous conjunctivitis and healed trachoma. The Schirmer's test revealed less than 2 mm in both eyes with tear meniscus less than 2 mm. Biopsy of an associated palpebral conjunctival nodule was performed, in addition to a gallium scan, chest X-ray, and a serum angiotensin-converting enzyme (SACE) level. RESULTS: The culture showed beta-hemolytic streptococci. Gallium scan showed intake by both lacrimal glands. Her chest X-ray results were normal, as was the SACE level. Biopsy of the excised conjunctival nodule disclosed a noncaseating granulomatous reaction with epithelioid and giant cells, and chronic inflammatory cell infiltrate confirming a diagnosis of sarcoidosis. CONCLUSION: A multilobular, nodular, perilimbal mass as a unique manifestation of sarcoidosis is presented. A streptococcal membraneous conjunctivitis and healed trachoma superimposed. A review of sarcoidosis of the external eye is included.

Ocular sarcoidosis in Kuwait with a review of literature.

OBJECTIVE: To study 18 cases of sarcoidosis, the hall mark of which was uveitis. SETTING: Referrals from peripheral eye clinics. PATIENTS: 18 patients with bilateral almost symmetric uveitis, negative Mantoux test and positive gallium scan were enrolled in the study. Preliminary bronchoscopy and bronchial lavage were not done due to social habits. RESULTS: Age ranged between 7-48 years with median 15 and mean 19 years. Although the patients were multinational, yet all of them were residents of Kuwait. A father and son were affected within 8 months period. 78% were strictly ocular, associated pulmonary and salivary gland affection 11% each. Sole anterior uveitis was found in 28%, associated with intermediate uveitis in 55% and with posterior in 16.6% of cases. Clinically detectable dry eyes associated 33% of cases. All our patients developed glaucoma which resolved with treatment of uveitis in 88% of them. Gallium uptake of the eye balls was found in 22%, of the lacrimal glands (panda sign) in 67%, and of the salivary glands or chest 11% each. Positive biopsy was found in 72%, 22% of which was conjunctival. Chest X-ray and SACE were positive in 11%. 61% had hypergammaglobulinaemia and all had negative ANA and RF. CONCLUSIONS: (1) 61% of ocular sarcoidosis presented below sarcoid age. (2) Multinationality together with father's and son's affection indicate a climatic or environmental insult in an already predisposed person. (3) Routine chest X-ray and SACE may not be adequate for diagnosis of ocular sarcoidosis. Gallium should be done in suspected cases. (4) Follow-up for prospects is emphasized.

Congenital hereditary autosomal recessive alacrima.

This report describes two phenotypically normal sisters, each married to a phenotypically normal paternal cousin. One couple had one female and one male child with alacrima; the other couple had a similarly affected girl. The keratitis sicca was manifested by punctate staining of the conjunctiva and blotchy staining of the cornea in the interpalpebral zone with fluorescein and Rose Bengal. Apart from an associated atopy in one of the children, pharmacological testing, biochemical analysis, and clinical examination suggested dysfunction of the lacrimal glands. We propose that the alacrima in this family is inherited in an autosomal recessive fashion.

Conjunctival ulcer in a patient with Crohn's disease.

A 38-year-old woman with documented Crohn's disease (CD) had uniocular nodular episcleritis and a limbal nodule with surrounding infiltrate, which, when healed, left residual pannus. The episcleral nodule was abnormally large (7 x 5 x 3 mm). A localized conjunctival ulceration, a rare manifestation, to our knowledge not previously reported, developed later in the same eye. Impression cytology of the ulcer showed pyknotic conjunctival epithelium and absence of goblet cells, together with the presence of a few plasma cells, lymphocytes, and macrophages. These features are comparable to those seen in the intestinal mucosa of patients with CD. The unilaterality of the ocular infection together with the good response to local therapy suggests that a local antigen-antibody immune complex reaction was involved. We recommend local therapy as a first treatment option.